Account Management Tool Configuration

There are two layers that capture cost share information ultimately stored in the participant’s subscription. The highest level is at the Sponsor Contract level in the AMT and the Partner Services table entry (more info below). The next level down is at the participant level via Eligibility file or RTE participant data.

See Account Management Tool for more information.

NOTE: If an EF leaves any relevant field blank, the subscription inherits a value set at the Contract/Partner Services level.

Field	Description	Acceptable Values	Notes
Contracted Rate/ HSA visit Cost	Patient visit responsibility dollar amount for HSA subscriptions. If claims are sent outbound, this is the Total Visit Cost that will be sent on the claim for both HSA and non-HSA subscription types.	Numeric	Often represents Fair Market Value (FMV) 100% always paid by the HSA plan participant for initial visits until deductible has been met. Required for PPO plans for claims.
Non-HSA Copay	Patient visit responsibility dollar amount for non-HSA subscriptions such as PPO, EPO, UNKNOWN, UNINSURED, HMO.	Numeric	Based on EF subscriptionType Always paid by the non-HSA plan participant for initial visits until OOP max has been met.
Waiver	When checked (Y), the patient’s associated to this contract will be charged $0 for a visit regardless of subscription type.		Enables customers to waive the patient charge for visits at the contract / subscription level (Supports regulatory requirements such as CARES Act). Impacts what the patient is charged for the visit. If claims are enabled, `contractedRate` is still sent in the claim as `totalCharge` to represent the cost/FMV of the service.
Optional Fallback copays	Set optional fallback values for the non-HSA subscription types that will override what is set as Non-HSA Copay.		Example: Non-HSA Copay might be set to $0 but you could define EPO as $5.00. For a contract that contains a mix of HSA, PPO, EPO, and UNKNOWN, the following would occur for per-visit fees: HSA: Whatever the Contracted Rate / HSA visit Cost is set to PPO: Whatever Non-HSA Copay is set to UNKNOWN: Whatever Non-HSA Copay is set to EPO: In this example, $5.00